Palliative medicine · 2026
Demographic and clinical characteristics, practices, and outcomes of continuous palliative sedation: A multi-setting, province-wide retrospective cohort study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Gagnon Bruno, Downar James, Nguyen Olivia, Marcoux Isabelle, Guay Diane, Marquis Marc-Antoine, Tshibangu René-Fabrice Mukendi, Boivin Jessica, Labeau-Caouette Mathilde, Savin Anton, Parsons Henrique A
Аннотация
BACKGROUND: This study leverages the Province of Quebec (Canada)'s 2014 End-of-Life Care Act, which regulates the use of continuous palliative sedation and mandates its reporting, to describe its use at a population-based level.
AIM: To describe the demographic and clinical characteristics of patients who received continuous palliative sedation, and to examine variabilities in clinical practice across diagnoses, indications, and care settings.
DESIGN: Retrospective convenience cohort of patients who received continuous palliative sedation until death.
SETTING/PARTICIPANTS: A total of 1005 patients' reporting forms from academic and regional hospitals and hospices between January 1st, 2016 and March 31st, 2022 were analyzed, representing 12% of all reported continuous palliative sedations performed in the Province of Quebec.
RESULTS: The sample was 51% male, median age of 73 years (IQR 64-81). Most (45%) received continuous palliative sedation in academic hospitals, 40% in hospices, and 15% in regional hospitals, but none in chronic care institutions or at home. Cancer was the most prevalent diagnosis (78%). The main indications were psychological/existential distress (57%), respiratory distress (34%), pain (28%), and delirium (24%); half had more than one form of distress. Overall median duration was 2 days (IQR 1-5), significantly longer in cases of psychological/existential distress (3 days, IQR 1-7; p < 0.0001). Medications commonly used were methotrimeprazine (74%), midazolam (69%), and lorazepam (48%), frequently in combination. 93% of patients died peacefully, while 6% experienced incomplete symptom relief, and 1%, complications.
CONCLUSIONS: The study demonstrated that standardization in the practice of continuous palliative sedation can be achieved across diverse clinical settings.
AIM: To describe the demographic and clinical characteristics of patients who received continuous palliative sedation, and to examine variabilities in clinical practice across diagnoses, indications, and care settings.
DESIGN: Retrospective convenience cohort of patients who received continuous palliative sedation until death.
SETTING/PARTICIPANTS: A total of 1005 patients' reporting forms from academic and regional hospitals and hospices between January 1st, 2016 and March 31st, 2022 were analyzed, representing 12% of all reported continuous palliative sedations performed in the Province of Quebec.
RESULTS: The sample was 51% male, median age of 73 years (IQR 64-81). Most (45%) received continuous palliative sedation in academic hospitals, 40% in hospices, and 15% in regional hospitals, but none in chronic care institutions or at home. Cancer was the most prevalent diagnosis (78%). The main indications were psychological/existential distress (57%), respiratory distress (34%), pain (28%), and delirium (24%); half had more than one form of distress. Overall median duration was 2 days (IQR 1-5), significantly longer in cases of psychological/existential distress (3 days, IQR 1-7; p < 0.0001). Medications commonly used were methotrimeprazine (74%), midazolam (69%), and lorazepam (48%), frequently in combination. 93% of patients died peacefully, while 6% experienced incomplete symptom relief, and 1%, complications.
CONCLUSIONS: The study demonstrated that standardization in the practice of continuous palliative sedation can be achieved across diverse clinical settings.